Managing Dry Eyes and Dry Mouth (Sicca Symptoms)

What are sicca symptoms?

Sicca is the medical term for dryness — specifically dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia). These symptoms are extremely common in autoimmune conditions, especially Sjögren’s disease, but they also show up alongside rheumatoid arthritis, lupus, and as side effects of certain medications.

Sicca symptoms are more than an inconvenience. Untreated dry eyes can damage the cornea. Untreated dry mouth accelerates tooth decay and increases the risk of oral infections. The good news is that a layered approach — combining simple over-the-counter products, environmental changes, and prescription options when needed — can make a real difference in comfort and long-term health.

Artificial tears and eye lubrication

• Use preservative-free artificial tears — brands like Refresh, Systane, and TheraTears all make preservative-free formulations (look for single-use vials or bottles labeled “PF”)
• Preserved drops are fine for occasional use, but if you’re using drops more than four times a day, switch to preservative-free to avoid irritation from the preservatives themselves
• Start with 4–6 times daily and adjust based on comfort — there is no upper limit on preservative-free tears
• At bedtime, use a thicker lubricating ointment such as Refresh PM or GenTeal Tears Severe — these blur vision temporarily but provide hours of moisture while you sleep
• If you wake up with eyes stuck shut or especially gritty, the nighttime ointment becomes even more important

Punctal plugs

Punctal plugs are tiny silicone or collagen inserts placed into the tear drainage ducts in the corners of your eyelids. They work by slowing tear drainage — keeping your natural tears (and artificial tears) on the eye surface longer.

• The procedure is quick, painless, and done in an ophthalmologist’s office
• Temporary collagen plugs dissolve in a few months and are sometimes used as a trial before permanent ones
• Silicone plugs last indefinitely but can be removed if needed
• Consider punctal plugs if artificial tears alone aren’t providing enough relief — they work alongside drops, not instead of them

Prescription options for dry eyes

When over-the-counter tears and plugs aren’t enough, prescription eye drops can help your eyes produce more of their own moisture:

• Restasis (cyclosporine ophthalmic) — reduces inflammation in the tear glands and increases tear production; takes 2–3 months of consistent use to see full benefit
• Xiidra (lifitegrast) — works through a different anti-inflammatory pathway; may work a bit faster than Restasis for some patients
• Both can cause temporary burning or stinging when instilled — this usually improves over a few weeks
• Your ophthalmologist will determine which is the better fit based on your specific situation

Managing dry mouth

Dry mouth is more than uncomfortable — saliva protects your teeth. Without adequate saliva, bacteria thrive and cavities develop rapidly, even in people who never had dental problems before.

• Biotène products — the rinse, gel, and spray are all designed for dry mouth and are available over the counter; the moisturizing gel is especially helpful overnight
• Sugar-free lozenges or hard candies stimulate whatever saliva production you have — xylitol-containing options are ideal because xylitol itself has mild anti-cavity properties
• Sip water frequently throughout the day — keep a water bottle within reach at all times
• Avoid alcohol-based mouthwashes — they worsen dryness; stick with Biotène or other alcohol-free rinses

Dental hygiene is critical. Use a fluoride rinse daily, brush with fluoride toothpaste, and see your dentist every 4–6 months rather than the standard 6–12. Tell your dentist about your dry mouth so they can apply professional fluoride treatments and monitor for early decay.

Prescription options for dry mouth

• Pilocarpine (Salagen) — stimulates the salivary glands to produce more saliva; typical dose is 5 mg three times daily; common side effects include sweating and flushing
• Cevimeline (Evoxac) — works similarly to pilocarpine but may cause less sweating in some patients; taken three times daily
• Both medications work best in patients who still have some functioning salivary gland tissue — they stimulate what’s left, so earlier treatment generally means better response

Environmental and lifestyle strategies

• Use a humidifier in your bedroom — especially during winter when indoor air is driest
• Avoid fans or air vents blowing on your face — direct airflow accelerates tear evaporation
• Wear wraparound sunglasses or moisture chamber glasses outdoors, especially on windy days — these shield your eyes from air currents
• Avoid decongestants and antihistamines when possible — many dry you out further; talk to us before taking them regularly
• Stay well hydrated, but know that drinking more water alone won’t cure sicca — the problem is glandular, not just hydration

When to see an ophthalmologist

You should manage mild dry eyes with artificial tears and environmental changes, but see an ophthalmologist if:

• Your eyes are persistently red, painful, or light-sensitive despite regular lubrication
• You notice blurred vision that doesn’t clear with blinking or drops
• Over-the-counter tears aren’t providing meaningful relief after a few weeks of consistent use
• You want to discuss punctal plugs or prescription drops

We work closely with ophthalmology and can refer you directly. Severe or worsening dry eyes need a slit-lamp examination to check for corneal damage that you can’t see or feel on your own.

Living with sicca symptoms

Sicca management is a daily routine, not a one-time fix. Most patients find a combination of approaches that keeps symptoms manageable. It may take some trial and error to find the right mix of products, and what works well may need adjustment over time — especially during seasonal changes or medication adjustments.

If your dryness is worsening despite these measures, let us know. Increasing sicca symptoms can sometimes signal a change in disease activity that needs attention beyond just managing the dryness itself.

This handout is provided for educational purposes and does not replace individualized medical advice. Always follow the specific instructions given by your rheumatologist.